With the Northern Territory’s Larapinta and Jatbula trails in her sights, translational research leader Professor Briony Dow is looking forward to more time for hiking and doing the things she wants to do when she wants to do them. Including work.
These lifestyle freedoms are now within her reach as Dow transitioned from director of the National Ageing Research Institute to honorary fellow at the end of May.
“I’m ready to do other things,” Dow tells Australian Ageing Agenda in her final week as director and after two decades with the Melbourne-based organisation.
“I’m not going to another job. I’m retiring effectively, although I’ll still work. I’ll just work to the extent that I want to,” says the 65-year-old. “I’ve got PhD students, and I’ve got research projects that I still want to contribute to. But I’m into bushwalking. There’s travel I want to do. I want to be able to go for a swim at 8 o’clock in the morning rather than having to go at 6 o’clock. It’s a lifestyle choice.”
Appointed director in 2015, Dow has led a range of aged care, social and clinical gerontology research programs during her time with NARI – an independent organisation focused on improving the life and health of older people through co-designed research and translation into evidence-based practice.
She’s incorporated her own research into elder abuse and carer mental health with the latter integral to the former social worker joining the organisation 21 years ago.
“I started out when I was finishing up my PhD and it happened to be on the exact topic that they were looking for a researcher to lead a project on,” explains Dow.
NARI was looking for someone to do an evaluation of home-based rehabilitation. Dow’s PhD was on the experience of family and carers when people get discharged home early for rehabilitation. “In the same area but looking at a different perspective,” she adds.
“It was just one of those interviews where… I’m like, okay, that was my thesis. I should get this job. If I don’t, I’ve done something really wrong.”
She didn’t do anything wrong, of course, and joined NARI as a research fellow in 2003. Dow had researched this area because of her previous job at Ballarat Health Services. She led a home-based rehabilitation program for four years that involved mostly older people recovering from strokes and joint replacements.
The inspiration for her PhD topic came via New Zealander Marilyn Waring – a public policy scholar and feminist.
“She gave this talk about women’s work and how it’s not even counted in any measures of productivity. So cooking a meal for someone; if you don’t pay for it, it is not counted. Whereas destroying an old growth forest is productive,” recalls Dow.
“I just got inspired by that lecture to think, wow, what I’m doing in the program that I’m running is relying on women at home to take on the care of the people who are now being discharged early for rehabilitation.”
She wanted to look at their experiences and how they felt about it. “I found in terms of the qualitative study that the carers often did quite like having the person at home because they could see that was better for their rehab, and also that they didn’t have to go in and out of hospital,” she says.
“But they weren’t being included in any of the decision-making. Yet some of the programs required you to have a carer to be able to be discharged. Yet they still didn’t talk to the carer about whether they were able to take that on board.”
Since then, Dow has published more than 120 peer-reviewed publications and 40 major reports to government. During this period she was also the president of the Australian Association of Gerontology – the nation’s professional body for experts on ageing.
You never would have heard about that 21 years ago
Reflecting on how things have changed, Dow says her work at NARI with the Victorian Government shows there is more of a focus on a person-centred and holistic approach to health services.
“I was just listening to a NARI seminar today and they were talking about trauma-informed physiotherapy, and I thought that you never would have heard about that 21 years ago – people would have just rolled their eyes. But now people are thinking we do have to engage the whole person in their health care, empower them to make decisions.”
On her specialist area of elder abuse – which “wasn’t even on the agenda 21 years ago”– the emergence of services and focus on prevention is another improvement, says Dow. “The evidence base behind that is something that I feel like I’ve personally contributed to and I feel is an achievement.”
Dow, however, landed in this area because of an opportunity to work with academics from University College London who had been doing work on elder abuse rather than something she set out to specialise in.
That work – which involved establishing definitions of elder abuse – left Dow realising Australia had no prevalence data and little knowledge about elder abuse and who was presenting to services.
She was involved in the first prevalence study by the Australian Institute of Family Studies including helping them work out their definitions and how to engage with culturally and linguistically diverse people.
“We did some early work with providers where we spoke to people who’ve experienced abuse, and that study still is unique,” she says. Former Age Discrimination Commissioner “Kay Patterson used to talk about it a lot because [previously] nobody had asked the people themselves about their experience and about what they would recommend to other older people.”
There’s a lot more knowledge about it now, says Dow. This includes about adult sons and daughters being the most likely perpetrators – and not those in care relationships as was once incorrectly thought.
“It’s better awareness. People are now also aware of more subtle forms, such as emotional abuse. Social abuse is something that people are more aware of where the family member isolates the older person and stops them getting the services they need,” she says.
NARI is doing some work on this with a Medical Research Future Fund study called No more shame that involves working with health professionals to identify elder abuse.
“We’ve developed a screening tool for health professionals to identify it, and to be trained in what to do next when they identify it. We’re actively working on that with 10 health services across Australia,” says Dow.
Another area of strong focus at NARI these days is research and resources for CALD communities. “When I first got there, we were just as guilty as anyone else of not really including people from other cultural groups in our research.”
While becoming aware 30 per cent of older people were from CALD backgrounds and translating some questionnaires, for example, Dow says NARI had lacked a good understanding of how best to work with CALD groups back then.
“Something that’s changed over the years is learning that you do need to immerse yourself in those communities, get to know them, get to have relationships and have your bilingual researchers so that you codesign the resources that you’ve developed with those groups.”
Closing policy and practice gaps
On improvements that still need to happen, Dow calls out the important role for research and evidence in policy and practice.
“It’d be good to see more mechanisms for enabling more fast-tracking and more user-friendly evidence-to-practice initiatives,” she tells AAA. “There’s still a big gap in the policy area and in practice as well. So how we make that happen is still a challenge.”
As a researcher, Dow says it feels “fantastic” when her research is picked up and becomes part of practice or somebody wants to adapt it for another area. “That’s what we’re there for,” she says.
“It’s so rewarding when that happens because it doesn’t happen often enough. We know a lot more about how we should be providing care than we are in hospitals and in aged care for a range of reasons. But if we could just have evidence-based care across the board, we would have reduced length of stays in hospital, we would have less falls, and older people and family members would have a lot less distress when they [encounter] health and aged care services.”
The main barrier to translating evidence into practice is the difficulty to make and sustain change, says Dow. There might be a focus on falls prevention, for example, for a month or even that year, but then there tends to be a regression to the normal way of doing things, she explains.
“Once that focus is removed – and we’re all guilty of this – you do what you’ve always done. Change is difficult and then, of course, there are all the challenges of time, expertise and money.”
As Dow prepares to embark on her own big change she talks warmly of her nine years as NARI’s director. Among the positives of the role is NARI’s collegial culture, she says. “We’re lucky in that we’re 60 people and the size is just right for the ability to get to know each other and work together as a team.”
Being the one who leads the team and seeing it grow in numbers and sophistication has been rewarding, says Dow.
“We’ve always been on about translational research, but we’ve become much more sophisticated in the way that we do that,” she says. “Over the time that I’ve been director, we’ve learned to do things like codesign a video using storyboards, and then getting professional photographers and actors in. And we can make videos about elder abuse in the context of dementia, for example.”
On her imminent departure from the organisation – and semi-retirement – Dow considers herself fortunate. “I love NARI. Working there has been amazing. But I’m also lucky I can choose.”
With new boots – a farewell gift from her NARI colleagues – to walk the Larapinta and Jatbula trails, Dow is also planning to travel. Such as to New Zealand to hike the Milford Track.
Dow and her husband are also into overnight hiking adventures. With a pack usually weighing 11-12 kilograms for such trips, Dow says she likes the sense of independence that comes with having everything she needs on her back.
“Between us we’ve got our cooking gear, sleeping gear and food and we just head off. And I like that feeling of freedom.”
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